Indiana
Professional Licensing Agency
Kenneth Daniel Shively
Controlled Substance Registration - Physician
License number
01024055B
Date granted
01/31/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
LAPORTE MEDICAL GROUP, 900 I STREET, LAPORTE IN 46350
indianalicensing.org
ID 5878205
LAST UPDATED 2024-03-21 03:35:00 UTC
LAST UPDATED 2024-03-21 03:35:00 UTC
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